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Spotlight on... awareness weeks

Awareness weeks guide

Spotlight on... awareness days, weeks and months

Featuring the latest research on key areas of health and wellbeing, our Spotlight on... series focuses on the awareness weeks, days and months that occur throughout the year.

Stay up-to-date on important health topics and explore the variety of resources available to support your work.

Christmas research 2024

Skin Cancer

Skin cancer occurs when skin cells are damaged, for example, by overexposure to ultraviolet (UV) radiation from the sun.

Every year, in Australia:

  • skin cancers account for around 80% of all newly diagnosed cancers
  • the majority of skin cancers are caused by exposure to the sun
  • the incidence of skin cancer is one of the highest in the world, two to three times the rates in Canada, the US and the UK.

Cancer council

UpToDate

Prevention

Diagnosis

General

Screening

Treatment

Cochrane Library

Guidelines

Online resources

Reports

Articles

Diagnosis

Prevention

Screening

Research

Treatment

E-books

E-journals

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Articles

Diagnosis

Impact of clinical information on Melanocytic Skin Lesion pathology diagnosis: A scoping review
Providing clinical information to pathologists may improve diagnostic confidence and interobserver agreement and result in upgrading of the histopathologic diagnosis. While providing the clinical diagnosis may prevent missing a progressive melanoma, more research is needed to determine the appropriateness of histopathology upgrading when clinical images are provided and the impacts on patient outcomes. JAMA 30 October 2024

Primary Cutaneous Melanoma—Management in 2024
Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. Journal of clinical medicine 11 March 2024

Health equity assessment of machine learning performance (HEAL): a framework and dermatology AI model case study
Analysis using the proposed HEAL framework showed that the dermatology AI model prioritised performance for race/ethnicity, sex (all conditions) and age (cancer conditions) subpopulations with respect to pre-existing health disparities. eClinicalMedicine 14 March 2024

Melanoma as a detection-dependent cancer: proxy measures of screening and surveillance associated with 3-year incidence of detection procedures for skin cancer in a national prospective study
People undergoing skin screening or surveillance subsequently experience higher rates of diagnostic scrutiny and higher rates of melanoma. British journal of dermatology 1 October 2024

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Prevention

A review of skin cancer primary prevention activities in primary care settings
These findings highlight potential opportunities for improving skin cancer prevention activities in primary care. Ensuring ease of program delivery, integration with early detection and availability of resources such as risk assessment tools are enablers to encourage and increase uptake of primary prevention behaviours in primary care, for both practitioners and patients. Public health research and practice 6 February 2024

Patient demographic characteristics and risk factors associated with sun protection behaviours in specialist melanoma clinics
These findings highlight the potential for targeting high-risk individuals with less frequent use of sun protection for patient education, public health messaging and ultimately improving sun protection behaviours. Australasian journal of dermatology 7 June 2024

Cost-effectiveness analysis and return on investment of SunSmart Western Australia to prevent skin cancer
Contribution to Health Promotion

  • Solar ultraviolet radiation is the main cause of skin cancer, and skin cancer prevention is feasible and effective through sun protection behaviours.
  • Skin cancer rates are growing around the world, and health and cost burdens are large and preventable.
  • This economic model combines the latest evidence to support the economic and health benefits of a population-based primary prevention intervention for skin cancer.
  • The high positive return on investment supports the business case for government investment in a state-wide SunSmart health promotion program for skin cancer prevention.

Health promotion international 7 August 2024

Global trends in cutaneous malignant melanoma incidence and mortality
This study highlights a global reduction of cutaneous malignant melanoma (CMM) mortality over the last three decades. The increasing awareness of risk factors, mainly related to UV exposure, along with early diagnosis and progress in treatment for advanced disease played pivotal roles in reducing CMM mortality, particularly in Australia. Melanoma research 1 June 2024

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Research

Risk of death due to Melanoma and other causes in patients with thin cutaneous Melanomas
In this study, the risk of melanoma-related death increased significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness. The risk of death from nonmelanoma-ralated causes was similar across Breslow thicknesses of 0.1 to 1.0 mm. This analysis suggests that a 0.8-mm threshold for guiding the care of patients with thin primary melanomas. JAMA 11 December 2024

The diagnosis and initial management of melanoma in Australia: findings from the prospective, population‐based QSkin study
The known: Primary cutaneous melanoma is common in Australia, but little is known about how incident cases are initially managed.
The new: More than 75% of primary melanomas in a large Queensland sample of people aged 40–69 years were diagnosed and managed in primary care. About half were managed by excisional biopsy at first presentation, 33% underwent shave biopsy, and 10% were initially managed by punch biopsy. Almost 80% required a second, wider excision, and 11% required three procedures.
The implications: Most incident melanomas are managed by primary care practitioners, underscoring the need for specific training in this important area of medical practice. MJA 15 May 2023

Changes in the incidence of melanoma in Australia, 2006–2021, by age group and ancestry: a modelling study
The known: Public health campaigns were initiated more than 40 years ago to reduce the risk of melanoma in Australia. Recent declines in melanoma incidence among young Australians have been interpreted as evidence of success, but the declines could be explained by the increasing population proportion of migrants at low risk of melanoma.  
The new: Our modelling indicates that the incidence of melanoma may be falling among people under 35 years of age in Australia, including those with high ancestral risk of melanoma.
The implications: Migration may have had an impact on the incidence of melanoma among younger Australians, but social changes may also have contributed to its decline. MJA 2 September 2024

Age group‐specific changes in keratinocyte cancer treatment rates in Australia, 2012–2021: a retrospective cohort study based on MBS claims data
The known: Treatment rates for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) (keratinocyte cancers) increased during 2000–2011 both overall and among Australians aged 55 years or older, but they declined among younger people.
The new: During 2012–2021, rates of treatment of younger Australians for histologically confirmed BCC/SCC continued to decline despite increasing biopsy rates. Overall treatment rates increased because of rises for older Australians (men aged 65 years or older, women aged 55 years or older).
The implications: The factors contributing to lower keratinocyte cancer treatment rates among younger Australians require further investigation. MJA 20 May 2024

Overview of skin cancer types and prevalence rates across continents
This review aims to explore the different types of skin cancer, their clinical features, and their worldwide prevalence based on the literature. Cancer pathogenesis and therapy 12 August 2024

Skin checks for potential skin cancers in general practice in Victoria, Australia: the upfront and downstream patterns and costs
Key points

  • Skin cancer is the most commonly diagnosed cancer in Australia, with annual treatment costs of around A$1.9 billion, but there is little published information about the skin checks leading to diagnosis and treatment
  • Skin checks occurred at around 1% of general practice encounters, almost all billed as standard or long GP consultations, and 20% of these had subsequent skin-related healthcare in general practice
  • Mean health system costs ranged from A$58 for skin checks without subsequent healthcare to A$595 for melanoma excisions

Public health research and practice 6 June 2024

The hidden Australian skin cancer epidemic, high-risk cutaneous squamous cell carcinoma: a narrative review
Deaths from non-melanoma skin cancers (NMSCs) have almost doubled in Australia in recent years. Cutaneous squamous cell carcinoma (cSCC) constitutes approximately 20% of NMSCs, but is responsible for most of the deaths. Most skin cancers are easy to diagnose and treat and therefore cSCC are often trivialised; however, there is a high-risk subgroup of cSCC (HRcSCC) that is associated with a high risk of metastasis and death. The definition of early HRcSCC and our ability to identify them is evolving. Many significant prognostic factors have been identified, but a universally accepted prognostic index does not exist. Guidelines for workup, treatment, and follow-up leave many important decisions open to broad interpretation by the treating physician or multidisciplinary team. Some of the treatments used for metastatic cSCC are not supported by robust evidence and the prognosis of metastatic cSCC is guarded. In this review, we highlight the rapid rise in NMSC deaths and discuss some of the deficiencies in our knowledge of how to define, diagnose, stage, and manage HRcSCC. Pathology 28 May 2024

Do large language model chatbots perform better than established patient information resources in answering patient questions? A comparative study on melanoma
Although Large language models (LLMs) show potential in providing highly personalized and complete responses to patient questions regarding melanoma, improving and safeguarding accuracy, reproducibility and accessibility is crucial before they can replace or complement conventional patient information resources (PIRs). British journal of dermatology 4 October 2024

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Screening

Implementation considerations for risk-tailored cancer screening in the population: A scoping review
Highlights

  • Risk-tailored cancer screening is foreseeable in the future.
  • Implementation is challenging at multiple levels.
  • Risk-tailored screening is largely acceptable and feasible to many populations.
  • Common barriers and facilitators to implementation exist across cancer types.
  • Testing and evaluation of implementation strategies is now crucial.

Preventative medicine 18 February 2024

Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants
Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma. Plos one 13 December 2023

Adherence to melanoma screening and surveillance skin check schedules tailored to personal risk
Population-wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk-based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. The authors aimed to determine adherence to personal risk-tailored melanoma skin check schedules and explore reasons influencing adherence. International journal of cancer 23 August 2024

Patients poorly recognize lesions of concern that are malignant melanomas: is self-screening the correct advice?
Only a small percentage of participants in this study were able to self-identify either in situ or invasive MM as a lesion of concern with a tendency to identify the more advanced, thicker malignant melanoma (MM). Given that MM is associated with a high mortality and cost of treatment, particularly when invasive, the inability of lay persons to identify these cancerous lesions will likely lead to delayed treatment and a possible adverse outcome. The authors believe the current melanoma screening practices in Australian general practice should be revisited to improve patient outcomes with regard to MM. Additionally, prevention campaigns should include images and primary risk factors for MM. PeerJ 3 July 2024

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Treatment

Immune checkpoint inhibitor therapy for advanced cutaneous squamous cell carcinoma in Australia: a retrospective real world cohort study
The known: Immune checkpoint inhibitor therapy for people with advanced cutaneous squamous cell carcinoma (CSCC) is associated with impressive response rates and durable disease control in clinical trials.
The new: Among Australians with advanced CSCC treated with immune checkpoint inhibitors outside clinical trials during 2017–22, therapeutic benefit and toxicity rates were comparable with those reported by more selective registrational immunotherapy trials.
The implications: Immune checkpoint inhibitor therapy could be safe and effective for a broad range of people with advanced CSCC, including immunocompromised people and those aged 80 years or more. MJA 5 February 2024

Quality measures in primary care skin cancer management: a qualitative study of the views of key informants
To service a growing population of skin cancer patients in Australia, the role of primary care needs to be more clearly specified, and its care providers supported and more engaged in quality improvement processes. Structure, process and outcome quality measures, derived from detailed guidance for primary care settings, can be used to track practitioner performance and facilitate ongoing improvement. BMJ open 11 July 2024

Management of cutaneous melanoma in Australia: a narrative review
Summary

  • Australia has one of the highest rates of cutaneous melanoma in the world. In the absence of a formal melanoma screening program, most screening in Australia is currently opportunistic and not tailored to an individual patient's risk.
  • Several melanoma risk prediction tools are available online, but most have not been externally validated, limiting their clinical uptake.
  • Advanced diagnostic technologies are becoming increasingly available, some of which are augmented with machine learning; however, their accuracy and role in clinical practice remains to be determined.
  • Surgery remains the foundation for treatment of primary melanoma and is based on complete resection of the primary lesion with appropriate clear margins. Sentinel lymph node biopsy, performed in certain patients with high risk pathological features in their primary melanoma, is the gold standard for determining regional lymph node involvement and provides prognostic information that can guide the use of adjuvant therapy.
  • In the past decade, the median survival of patients with advanced melanoma has increased from the order of a few months to potentially over five years due to the availability of immune checkpoint inhibitors and BRAF/MEK inhibiting targeted therapy. These treatments are also available in an adjuvant setting, halving the risk of recurrence after surgical resection of the primary tumour or following regional nodal resection.
  • A large community of melanoma survivors and their family, friends and carers are now actively involved in research efforts and play a central role in improving models of care and ensuring a holistic approach to patient management.

MJA 1 May 2023

Efficacy and toxicity of adjuvant radiotherapy in recurrent melanoma after adjuvant immunotherapy
What is already known on this topic:

  • There is an absence of prospective clinical trial data on the efficacy of adjuvant radiotherapy (RT) for patients with melanoma who relapse during or after adjuvant immunotherapy, as the landmark Trans-Tasman Radiation Oncology Group (TROG) 02.01 trial was conducted prior to the current era of adjuvant systemic therapies.

What this study adds:

  • This is the first study to investigate the role of adjuvant RT in patients with melanoma with locoregional disease recurrence during or after adjuvant anti-programmed cell death protein 1-based immunotherapy. Results demonstrate that adjuvant RT provides a benefit for locoregional disease control in the modern era of adjuvant systemic therapy.

How this study might affect research, practice or policy:

  • This study provides important preliminary data to support the use of adjuvant RT for locoregional disease control in appropriately selected patients with disease recurrence during or after adjuvant immunotherapy, and highlights the need for further prospective studies to validate these results.

Journal for ImmunoTherapy of Cancer 17 February 2023

Measuring the quality of skin cancer management in primary care: A scoping review
The aim of this scoping review was to better understand the literature on quality measurement of skin cancer management in primary care settings over the past decade. Australasian journal of dermatology 24 March 2023

Adjuvant radiation therapy in macroscopic regional nodal melanoma
Adjuvant radiation therapy (ART) for macroscopic regional nodal cutaneous melanoma is radiotherapy (RT) that is given after surgery to ensure that the nodal melanoma does not recur in the irradiated field. Prior to the discovery of effective drugs for melanoma, a high-quality trial showed that ART decreased in-field recurrence by 50%. After the advent of effective drugs, nodal melanoma is now treated with these drugs upfront, while local therapies like surgery and ART are reserved for nodal disease that progresses despite the drugs. RT has been found to be safe in this scenario. Cancers 25 November 2024

The impact of statins on melanoma survival: a systematic review and meta-analysis
Statin use may decrease recurrence and improve survival in patients with melanoma. In this systematic review and meta-analysis, the authors examine the current body of literature concerning the use of statins as an adjunctive therapy in melanoma Melanoma research 8 December 2024

Computational network analysis of two popular skin cancers provides insights into the molecular mechanisms and reveals common therapeutic targets
Basal Cell Carcinoma (BCC) and Actinic Keratosis (AK) are prevalent skin conditions with significant health complications. The molecular mechanisms underlying these conditions and their potential shared pathways remain ambiguous despite their prevalence. Therefore, this study aims to elucidate the common molecular pathways and potential therapeutic targets for BCC and AK through comprehensive computational network analysis. Heliyon 3 January 2025 

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E-books

This is just a sample of the e-books the library subscribes to – you will need your library login

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E-journals

A sample of e-journals available via the library catalogue

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